Review Question - QID 5860

Maintaining volar translation of the lunate after reduction of a comminuted distal radius fracture is recommended to help restore volar tilt.

Closed reduction and maintenance of alignment of a comminuted distal radius fracture with an external fixator has been shown to produce good healing and good functional outcomes. Traction across the fracture is used to help maintain radial length and alignment and bring fracture fragments together with ligamentotaxis. Volar translation of the lunate is used to help restore volar tilt.

Agee presents a review of distal radius fracture treatment with multiplanar ligamentotaxis using an external fixator. He notes that uniplanar ligamentotaxis, such as straight traction, typically does not restore volar tilt. He recommends also translating the carpus volarly, thus moving the lunate into a more volar position to achieve multiplanar ligamentotaxis and improve final alignment.

Agee et al. presents a review of distal radius fractures treated in an external fixator. He notes that the common position of reduction involves holding the wrist flexed and in ulnar deviation. He points out that this position is not functional and leads to significant stiffness of the fingers. They recommend holding the wrist in a neutral to extended position and allowing early range of motion of the fingers. They noted better functional outcomes, and even had restoration of volar tilt in 55% of cases despite the extended wrist position.

Incorrect answers:
Answer 2: Radial height and inclination are maintained with traction and ulnar deviation of the wrist.
Answers 3 and 4: Volar translation of the carpus has not been shown to increase or decrease the risk of non-union in distal radius fractures.
Answer 5: Volar translation of the lunate has not been shown to increase displacement amongst intraarticualr fracture fragments in distal radius fractures.